Two million cannot find NHS dentist

Last updated at 08:31 14 July 2005

MPs have called on the Health Secretary Patricia Hewitt to help two million people in England who are unable to find an NHS dentist.

The House of Commons Public Accounts Committee report said that the Department of Health had repeatedly postponed elements of its plans to reform dentistry, and had missed several "key milestones" in the process.

Former chairman Edward Leigh said that time was fast running out for the Department to put arrangements in place for the reforms - including a new streamlined charging system - which are due to be implemented in April 2006.

He said the committee's inquiry - carried out under his chairmanship in the last Parliament - had uncovered "dismaying" variations in dental health across England, with adults in the north twice as likely to have lost all their teeth than southerners.

In 1999, Prime Minister Tony Blair promised that everyone who wanted NHS dental care would be able to access it by September 2001.

But today's report found that England has one of the highest ratios of patients to dentists of all European Union and G7 countries, with an estimated shortage of 1,850 dentists in 2003 and two million people unable to register for care on the NHS.

Socially deprived areas

Areas of high social deprivation - where tooth problems are worst - have fewest dentists, but even in more affluent areas many adult patients experience difficulties in registering for NHS treatment, found the report.

The committee called on the Department of Health to consider offering new incentives for dentists to stick with the NHS, and to consider giving higher priority to initiatives such as using access centres and mobile dental units to target areas of need.

It warned that the new charging system "may have unintended consequences both for dentists' willingness to provide treatment and for patients' willingness to pay".

The change could lead to an "exodus" from the NHS by dentists who may be able to provide some treatments cheaper privately, resulting in a loss of revenue from charges for the public sector, it said.

And it warned: "Dentists will no longer have a financial incentive to try and collect debts from patients who fail to pay the correct NHS charges for the treatments they receive because, under the new system, dentists' income is guaranteed for three years and is not dependent on the level of charge income."

Government failures

The committee said that the Department of Health had missed several "key milestones" in its programme of reform for dental services, including a six-month delay in the introduction of new contracts, initially planned for April this year but put back to October.

And it said it was "extremely concerned" that the Government was handing responsibility for managing the new contracts to Primary Care Trusts without first ensuring that they had the expertise and resources for the job.

The report said that children in England had lower levels of tooth decay on average than in other European countries, but found strong regional variations in the extent of decay in both adults and children.

"Children in some parts of northern England have on average twice the level of dental decay of children in some other parts of the country," said the report. "Adults in northern England are twice as likely to have no natural teeth as those in the south."

Mr Leigh said: "It is well and good that 12-year-old children in England have healthier teeth than their European counterparts.

"But the wide variations in oral health within this country are dismaying. And people all over the country - according to current estimates, a staggering 2 million - are involved in the fruitless quest of trying to register with an NHS dentist.

"The Department of Health has once again postponed implementation of its ambitious programme for reforming NHS dentistry, to April 2006. Some details of the programme are finally starting to emerge - proposed patient charges were put out to consultation last week after a long delay - but time is fast running out to develop a system to which all parties can agree.

"Whether Primary Care Trusts, given the responsibility of managing the new contractual arrangements, have enough time to acquire the right expertise and resources must also be open to question.

"These are far-reaching changes and there is still much work to do to reduce uncertainty and to win over a sceptical dental profession. If this fails, the Department's attempts to cure NHS dentistry may turn into something that seriously damages its health."

Most of the 23,000 dentists in England provide both NHS and private dentistry services, but an increasing number have cut down their NHS work in recent years.

In 2003-04 total expenditure on dentistry in England was some £3.8 billion, of which £2.3 billion was accounted for by the NHS and an estimated £1.5 billion by private dentistry. The NHS recovered £0.5 billion of this expenditure from patient charges.